Trends in Endogenous Endophthalmitis in Rural and Urban Settings in the United States

ABSTRACT

Purpose

The objective of this study is to explore and compare trends in urban and rural cases of endogenous endophthalmitis (EE) in the United States.

Methods

This study utilizes data from the 2002–2014 National Inpatient Sample (NIS) Database. Disease diagnoses and procedures were identified using codes from the International Classification of Diseases, Ninth Revision (ICD-9). Cases of EE were defined as cases of endophthalmitis in the setting of bacteremia or candidemia without a recent history of ocular trauma. The NIS Database defines urban and rural hospitals based on the hospital county’s population statistics. Statistical analysis was performed using IBM SPSS 23.

Results

We identified 8255 cases of EE. Of these cases, 523 (6.3%) occurred in rural areas; 7733 (93.7%) occurred in urban areas. Of the cases of EE, 7692 (93.2%) were bacterial EE, 412 (5.0%) were candida EE, and 151 (1.8%) were mixed EE. Candida EE was observed in 1.7% of rural cases and 5.2% of urban cases (p < .001). Pars plana vitrectomies were performed more often in urban hospitals than in rural hospitals (11.5% vs. 2.9%; p < .001).

Conclusion

Endogenous endophthalmitis remains a rare but devastating ocular infection. In this study, we have demonstrated that there are important differences in cases of EE that present to urban and rural hospitals. Future investigations into these differences in patient demographics, source/systemic infections, and hospital courses may allow clinicians and hospitals to develop a more targeted approach to treating EE based on the type of community from which the patient presents.

KEYWORDS:

• Endophthalmitis
• Bacteremia
• Candidemia
• Endogenous Endophthalmitis
• Intraocular Infection

Financial support

There was no financial support or funding for this study.

Disclosure statement

1. Aditya Uppuluri does not have any financial disclosures.

2. Marco A. Zarbin is a consultant for Boehringer Ingelheim, Genentech/Roche, Frequency Therapeutics, Iduna, Iveric Bio, LIfe Biosciences, Novartis Pharma AG, Ophthotech, Perfuse Therapeutics, and Selphagy. He owns equity in Frequency Therapeutics, Iveric Bio, and NVasc (Co-Founder).

3. Neelakshi Bhagat does not have any financial disclosures.

Prior submissions/publications

This manuscript has not been published anywhere previously, and it is not in simultaneous consideration for publication in another journal. The manuscript has not been submitted to any journal prior to this current submission.

Data availability

This study utilizes data contained in the National Inpatient Sample Database, which is available for purchase on the Healthcare Cost and Utilization Project’s website.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.